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During the past few years, thousands of physicians have begun selling health-related multilevel products to patients in their offices. The companies most involved appear to be Amway, Body Wise, Nu Skin (Interior Design), and Rexall. Doctors are typically recruited with promises that the extra income will replace income lost to managed care.
In December 1997, the American Medical Association Council on Ethical and Judicial Affairs (CEJA) advised against against selling "non-health-related products" to their patients. CEJA's policy statement hit hard at the potential conflict of interest and pressure inherent in such sales:
The for-profit sale of goods to patients by physicians inherently creates a conflict of interest. Physicians engaging in this activity have a direct financial interest in selling the goods to patients; but the sale may or may not be in the best interests of the patients. Physicians may be tempted to sell items for profit even though their patients do not need the products. Even if most physicians are capable of resisting such temptation, the more ethical course is for professionals to avoid placing themselves in temptation's way, This conflict of interest is particularly troubling in the office setting, where most patients appear because they are in need of medical attention. In the ordinary market setting, consumers can be trusted not to purchase items which they do not want, thus a voluntary sales transaction is taken to be in the best interests of both parties. But the voluntariness of any sale to a patient in a medical office setting is open to serious question. . . .
The offer of goods In the treatment setting puts subtle pressure on sick and vulnerable patients to purchase them. Patients may purchase goods out of a misplaced desire to please or to "get in good" with their physicians. They may feel that they have to purchase those goods in order to secure the physician's favor. These feelings, whether justified or not, may interfere with the open exchange and the level of trust between physician and patient 
Although the statement did not mention products sold through multilevel marketing, CEJA chairman Robert M. Tenery, Jr., M.D., latr said that it had been triggered by the growing number of physicians who had added an Amway distributorship to their practice . Amway responded:
The Amway Rules of Conduct expressly prohibit distributors from selling or displaying Amway products or services in retail establishments, which includes professional offices .
In June 1998, AMA House of Delegates voted to return the report to CEJA for clarification and rewording. During the heated discussion, supporters of the measure expressed alarm about the sale of "neutraceuticals" and "cosmeticeuticals." An alternate delegate from Kansas, for example, said: "We have a number of people . . . who are frankly acting like quacks. They sell vitamins that are not efficacious for their patients." .
In June 1999, the AMA House of Delegates narrowly approved new ethical guidelines emphasizing that physicians should not coerce patients to purchase health-related products or recruit them to participate in marketing programs in which the physician personally benefits, financially or otherwise, from the efforts of their patients. The guidelines clearly frown on doctors profiting from the sale of health-related nonprescription products such as dietary supplements, safety devices, and skin-care products similar to those to available at local pharmacies or health-products stores [4-6]. But for those who do, they outline several limits:
My concern goes beyond the conflict-of-interest inherent in MLM sales by health professionals. Most health-related MLM products are either useless, irrationally formulated, marketed with unsubstantiated claims, and/or overpriced. Many patients are being invited to spend upwards of $50 per month for such products. Such solicitations reflect poor medical judgment, lack of ethics, or both. Patients who can benefit from taking dietary supplements can get them for much less money at a pharmacy or health-food store.